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Your full name, first then last  
Email Address   Phone Number
Address Unit # City Zip
Nearest major cross street
Square footage of your home # Bedrooms # Bathrooms    # Stories
Rate the cleanliness of your home as:  Excellent   Good fair Needs help
How many pets in home How many children in home  Total number of people  in home  
What type of cleaning service are you looking for? Please check the appropriate button below
Weekly   Bi-monthly Monthly One time only Moving out of home
If you have specific cleaning requests or any questions about our service, please use the text box below
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INTERNET SPECIAL - You will get $5 off your first cleaning if you tell us how you found us
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Home Maid Housekeeping Agency respects your privacy. We do not sell or share your personal information with anybody. THANK YOU! - Call 760-439-4444 or EMAIL for more information